Primary nonseminomatous germ cell tumors of the mediastinum

Between 1987 and 1996, five male patients ranging from 9 to 39 years old (median, 23 years), were treated for nonseminomatous germ cell tumors that appeared to arise in the anterior mediastinum without clinical involvement of the testes. The most common presenting symptom was chest pain, and the mean diameter of the tumor was 13.7 cm (range: 10.5 to 18 cm). Tumor markers were measured in four patients and all had a raised alpha-fetoprotein (AFP) level (range: 453.5 ug/L to 16469 ug/L). Echo-guided needle biopsies were performed in all five patients and only two of them had definite diagnosis. The diagnosis of the other three patients could only be obtained through exploratory sternotomy. Among these five patients, one was treated with primary surgical intervention followed by chemotherapy. He died of complications of chemotherapy one month later. Another patient who received only an operation died of surgical complications eight days after the operation. The other three patients underwent cisplatin-based chemotherapy after the diagnosis of nonseminomatous germ cell tumors was made. One of them received further radiotherapy for the residual mass on chest x-ray film after normalization of the tumor markers. He died of liver metastasis 7 months after the operation. Those two patients who received surgical excision of the residual mass after completion of chemotherapy and normalization of the tumor markers were still alive at 9 years and 12 months after the operation. The modern multimodality treatment, including cisplatin-based chemotherapy coupled with adjunctive surgery if necessary, does provide a better chance of survival in our patients of primary nonseminomatous germ cell tumors of the mediastinum.